ABSTRACT
Background : Small ductules communicating with the bile ducts have been described at the porta hepatis in extrahepatic biliary atresia (EHBA) and these form the basis for hepatic portoenterostomy. The use of cholagogues like dehydrocholic acid (DHC) and ursodeoxycholic acid (UDCA) to enhance bile flow postoperatively has been reported. Aims : This communication describes our experience with the use of cholagogues following surgery in EHBA and attempts to correlate the outcomes with the diameter of the ductules. Material and methods : Fifty five EHBA patients treated by the Kasai procedure form the basis of this study; 35 patients treated during 1979-1986 and administered DHC (3-5mg/kg) postoperatively and 20 patients treated during 1999-2002 and administered UDCA (15mg/kg) postoperatively. The diameter of ductules was measured using an optical micrometer on 5μm serial sections; the ducts were classified as type I (no demonstrable ducts, n=14), type II (<50μm, n=22) and type III (>50μm, n=19). The clinical outcome was categorized as 1 (jaundice free survival at 5 years follow-up, n=7), 2 (initial good response but deteriorated after one year, n=27) and 3 (expired within one year following surgery, n=21). The response to surgery was monitored using biochemical liver function tests (LFT), hepatobiliary scintigraphy (HIDA scan) and occurrence of cholangitis. Results : Age did not affect the size of ducts in both DHC and UDCA groups but patients in the DHC group were older than those treated with UDCA (mean age DHC: 105.22+33.53 days, UDCA: 74.68+23.73 days; p=0.009). There was no statistically significant difference between duct size and postoperative LFT in both groups (DHC p=0.1, UDCA p=0.5). Bile excretion on HIDA scan was significantly better with larger ducts (DHC p=0.003, UDCA p=0.025); overall UDCA showed significantly better bile excretion (p=0.003) but this was not reflected in the surgical outcome. There was no significant difference in the surgical outcome of those treated with DHC or UDCA but a significantly higher incidence of cholangitis was seen with smaller ducts in the UDCA group (p=0.02). Conclusions : There was no correlation between duct diameter and postoperative LFT but type III ducts were associated with better bile flow on HIDA scan. Cholangitis was seen more often with type I and II ducts in both DHC and UDCA groups. UDCA administration seemed to be beneficial in patients with type III ducts in increasing bile flow and reducing cholangitis.
ABSTRACT
A twelve year retrospective review of poisoning fatalities was undertaken in the tertiary care referral hospital of Kasturba Medical College, Manipal, South India. Of the 1917 cases of forensic autopsies conducted, 372 cases (79.4%) were due to poisoning deaths. There was an increasing trend observed in the number of poisoning deaths from the period 1993-94 to 1999-2000, followed by a declining trend during 2003-04. Ninety two percent of the fatalities were due to self-poisoning, with 77% due to pesticide consumption. Majority of the cases occurred in the rural areas during winter season. Many of the decedents were men (73.1%) in their 3rd decade of life. Suggestions are being offered on the basis of this study for the control of pesticide poisoning.
ABSTRACT
Snakebite is of grave concern in most parts of India. Being a tropical country with an extensive coastline, India is home to a variety of snakes both poisonous and non-poisonous. This is a retrospective research study conducted at Kasturba Hospital, Manipal, which is a tertiary care teaching hospital situated in Coastal Karnataka, South India. During a three-year period starting from 1st January 2001 to 31st December 2003, one hundred and twenty six cases of snakebites that were admitted at Kasturba Hospital, Manipal were studied. The commonest age group affected was 21-30 years with a male preponderance (66.7%). The victims were agriculturists in 54 cases. Most of the bites occurred during summer. Bites occurred when the victim was outdoors in 72.2% of the cases. Lower limb was commonly involved. Double fang mark was seen in 47.6% of the cases. Non-poisonous snakebite was seen in 38.1% of the cases. One hundred and twenty patients survived, and 6 persons died, representing a mortality of 4.8%.
ABSTRACT
The main objective of this study was to collect data with regard to the pattern of acute methyl parathion poisoning in this part of the world. One hundred and fifty three patients with organophosphate poisoning presented to Kasturba Hospital, Manipal between January 2001 and December 2002, out of which 58 cases (37.9%) were due to methyl parathion exposure. The commonest reason for poisoning was suicide (98.2%). A significant proportion of victims were male (72.4%), many in the 21–30 years age group (43.1%). In 77.5% of the cases, the poisoning incident occurred during daytime. Manifestations were predominantly muscarinic in nature, and the median value of serum pseudocholinesterase at admission was 2407.5 IU/L. Respiratory failure was the commonest complication (41.2%). 25.8% of the cases ended in death, and 40% of these succumbed within 24 hours of exposure.